26 June, 2006

Politics have little place in forensic science, yet the human factor allows political agenda to creep into the least appropriate places. Our office was unfortunate enough to be a focus of local political and media attention for over a year and even the subject of national attention for a short time. This was not a pleasant time for any of us.

If you have read the previous entry with the article entitled "Dead Reckoning," then you have already learned about the case that started this all. In summary, five high school girls died in a single-vehicle crash one March afternoon while returning from prom dress shopping. Initially, it was unclear as to what caused the accident and only this was known: the vehicle was traveling at a high rate of speed, left no skid or yaw marks indicating attempts to brake, and it collided into a high embankment. Four of the five girls were killed on impact, and one was transported to Hospital at UPenn (HUP) by helicopter where she was pronounced dead in the ER.

The accident, along with a series of events that sparked afterwards, changed many lives.

Our office worked in conjunction with the Pennsylvania State Police to determine what caused the crash. One key piece of evidence obtained but not recognized immediately as important was the presence of several cans of Duster II, a compressed air keyboard cleaner, found in the back seat of the vehicle. When preliminary toxicology reports were obtained, propane was discovered in the driver's blood. As this is an odd finding, our chief forensic pathologist, Dimitri Contostavlos, became suspicious that inhalants may have been involved and began researching the practice of "huffing" propellant-based substances. What he found was that this was becoming an increasingly popular method of obtaining a high, particularly among teens.

Several problems exist with this practice. The chemicals in the propellants displace oxygen in the brain, which is dangerous in itself. Huffing can also cause sudden cardiac arrest, nerve damage, brain damage on several levels (especially with prolonged use), and damage to internal organs. Additionally, it causes temporary loss of consciousness or impairment. In the case of the girls' deaths, upon further toxicology tests it was found that not only did all four of the decedents who came into our office have the Duster II chemicals on board, but the driver had the highest levels.

From the parents' perspectives, this was already a nightmare. Add to the nightmare the discovery that their daughters had been engaging in a dangerous activity that directly lead to their deaths. That is a tough pill to swallow. Our pathologist spoke to the PSP about releasing the information, first to the parents, then to the media in order to properly educate the public about the huffing trend. Somewhere, it seems, communication deteriorated. The State Police did not notify the families of the release to the media. Dr. Contostavlos had spoken to the families but did not realize that they were unaware that the information was being released. Hence, although the families were aware of the circumstances, they were surprised to read about the findings in the county newspaper the day after they were informed.

This caused an uproar. I cannot imagine what the parents must have been going through. I do know that the media seemed all too pleased to talk to the parents and publish their outrage. At what? The fact that their daughters died because they were engaging in a dangerous practice that apparently puts many young people at risk? No. They were outraged at Dr. Contostavlos. In forensics, we are frequently the target of grief and rage, and to an extent, this is accepted by most who work in the field, however misdirected it might be. I personally have had people scream at me not to take their deceased loved one away from them. The Grim Reaper image is one that goes with the territory.

This, however, went beyond all reason. The parents went to the press and the county council demanding that Dr. Contostavlos be fired. Their argument was that there was no medical evidence to suggest that huffing caused the accident or that their daughters deliberately inhaled the contents of the cans. They were angered by the release of these findings to the media without first discussing it with them, and it seemed not to matter that the PSP had a role in not informing them of this.

I can say this: Dr. Contostavlos probably should have arranged a meeting with the families prior to the press release. Clearly, relying on the PSP to do this, whether or not they offered, was a mistake. He would be the first to admit that talking with families was his least honed skill, and that he lacked patience and sometimes tact, but in retrospect, this might have prevented some of the repercussions.

Maybe.

There is a good chance that nothing he could have done would have made any difference. He couldn't change the facts, nor could he summon the dead to rise again. Nothing less was acceptable.

During the year that followed this tragic accident, many things were uncovered. The parents all insisted that their children were completely drug and alcohol free and would not have dreamed of huffing from aerosol containers. But it was learned that the girls, hailed by the media as "the five angels," certainly had their share of problems in life. One had been in rehab for cocaine abuse. The fifth girl, who died at HUP and became a Philadelphia Medical Examiner's case, was found to have both the propellant chemicals and marijuana in her system. Does this make them bad people or troublesome teens? Of course not. It does indicate that at least two of them had prior experience with the use of a controlled substance. Angels? Perhaps by some definitions. Drug free? Not so.

This does not and should not take away from the grief felt by families, friends, and the community at this loss. It hit our office personally, as our secretary was very close with one girl's mother. As hype rose among the media and politicians and surrounding community, tension rose in our small office. There was as much of a riff in our office as among the county residents. Some were very sympathetic towards the parents; in particular, the family of a girl who had been killed a year before while driving drunk and high, and who also paralyzed her friend. The father of the injured girl spoke out in favor of Dr. Contostavlos and his efforts to not only defend his findings, but to educate the public about this apparent huffing problem. For months, the case was in the newspapers and on TV almost daily, and it seemed to be all anyone in the county spoke about. It was the subject of radio call-in programs.

County Council eventually succumbed to the pressure of the most vocal members of their constituency and announced that after 20 years, they would not be automatically renewing Dr. Contostavlos's contract as Medical Examiner. Rather, they would interview several candidates, and he was welcome to apply for the position as well. This political tactic came as no real surprise to anyone who had been involved with or followed the story.

That is when the nightmare really began for us.

Dr. Contostavlos is someone for whom I have and always had tremendous respect. From the first day I walked into his morgue, he educated me unrelentingly about pathology, scene investigation, medicine, and many other aspects of forensics. While he was not always good with people, he was by no means always bad with people. I have heard him speak comfortingly and empathetically to families who have lost someone, in person and on the phone. I have also known him to be blunt with families when challenged, but not frequently. I've seen him throw things and I've seen him hug people. I saw and heard him lose his temper at staff members and police many, many times. I've seen him pick his nose and flick his "findings" across the room. Cultured and alternately crass, kindly and beastly, logical and outrageous, the man is a true paradox.

When it was announced that the position of Chief Medical Examiner would be opening up, we were not shocked, yet we had no idea how this walking paradox of a man was going to react.

His initial response to the media attention was to launch a rather expansive educational campaign. He spoke to schools, parent groups, police, and hospitals basically anyone who expressed interest in an effort to broaden awareness about the practice and dangers of huffing. While he did a considerable amount of anticipated ranting in the office, it seemed he was channeling this fervor in a positive way, at least publicly. Then Dr. Contostavlos was interviewed on 20/20 after the story began getting national attention. Here is the interview summary:

MEDICAL EXAMINER LET GO AFTER CONTROVERSIAL RULING IN THE

DEATHS OF FIVE TEENAGERS; CHRIS CUOMO REPORTS ON A REPORT

THAT TORE A COMMUNITY APART, ON ABC NEWS “20/20 DOWNTOWN”

A month after five high school senior girls died in a tragic car accident, the county medical examiner determined that four of the girls had been inhaling a potentially toxic cleanser, an inhalant commonly abused by teenagers. The report outraged the community; and a year later, the medical examiner’s contract was not renewed. Was it a case of killing the messenger?

“I think it’s a common thing to blame the messenger of bad news. I think that’s what it is,” says the former medical examiner, Dr. Dimitri Contostavlos, who was the county’s medical examiner for 20 years. And, according to the National Inhalant Prevention Coalition, inhalant use is a widespread problem in Delaware County, where the senior girls attended high school in suburban Philadelphia. “Seniors in Delaware County had two times the usage levels of inhalants as anybody else in the state or the country,” said Isabel Burk, who works for the Coalition.

The head of the local county government says the Delaware County Council had plenty of reasons to be unhappy with the doctor and insists its action was not in retaliation for the examiner’s report about the accident. Last week, the county council suspended Dr. Contostavlos immediately, claiming that he had created a hostile working environment in his office and had engaged in “many instances of bizarre, outrageous, and completely inappropriate behavior.”

Others disagree and say Dr. Contostavlos is paying the price for uncovering a community’s ugly secret. “I think in America we do kill the messenger. It’s very difficult to be a truth teller in America today. You usually end up sacrificing something and often, it’s your job and your livelihood,” Ms. Burk tells Mr. Cuomo.

Elizabeth Vargas is the host of the March 9 edition of “20/20 Downtown.” Victor Neufeld is the executive producer.

As time progressed, Dr. Contostavlos seemed to regress, until for all appearances, he had he lost perspective. While the candidates were being selected to interview for the position, he joined online groups and forums (except that he asked his staff to post what he wrote because he didn't want to deal with technology). He wrote scathing comments about other pathologists who were being interviewed, and continued to rant via email to listserve members about how he was being sabotaged by the county politicians.

It seemed that not a day went by without obsessive, paranoid ranting from the doctor. The tension in the office grew as the doctor began placing blame for the situation on everyone except the investigators and the autopsy technician, which is not to say that he did not subject us to it.

To make matters worse, in the heat of all of this, our investigative supervisor (who had an almost exclusively administrative role in the office), was involved in a drunk driving accident in which he injured himself and a family of three. He did not return to work due to injuries, and because of his DUI, he was ultimately asked to retire. It was more publicity, and it was all negative.

Eventually, three candidates were interviewed in addition to Dr. Contostavlos. Eventually, one was selected and an offer was made. It was at that time Dr. Contostavlos was given notice that his contract would expire approximately three months from then. The assistant pathologist, who had been the target of much rage from Dr. C. decided to move back to Oregon so he and his wife could be closer to their families. There was supposed to be a transitional period where the assistant pathologist and the new medical examiner would work together, then the assistant would leave.

This did not happen. Dr. Contostavlos seemed to further decompensate. He grew more openly hostile and paranoid every day, and his bursts of rage and fits of temper finally frightened a visitor to the point of reporting him to County Council. The next day, just as I came on duty for my rotation, he was escorted off of the property by county police and told he was not to return, except once when the office was not occupied and he was supervised, to gather his belongings.

It was a sad way to see such a gifted pathologist and fascinating person end his tenure at the Delaware County Medical Examiner's Office.

In the days and weeks that followed, there was still much media attention, but it did begin to wane a bit. But it was far from over, because then the Delaware County Criminal Investigation Division (CID) showed up at our office.

They began by segregating the staff and interrogating us about Dr. Contostavlos autopsy practices. It seemed that they were under pressure from the council to find something - anything - that would help publicly justify their reasons for removing him. I was honest and answered the detectives' questions. I don't know what was said in other interviews, but I do know that several people in the office loathed him. Others, like myself, seemed to accept him for who he was and just wanted the whole mess behind us. But before we knew it, terms like "corpse abuse" were appearing in the paper, and the media hype resumed.

Eventually, our new pathologist arrived and the public focus shifted to that. During this entire ordeal, we were still attempting to perform well in our daily forensic functions, which were difficult enough by nature. Was any lesson really learned? Refer to this chapter title; propagating "safe history" is the only way to remain inscrutable in a public domain. Publicizing controversial information, even with the best of intentions, and there is a good chance one will pay dearly for it. That might be as tragic to me as the deaths of these girls, themselves - the tragedy of which, in sad irony, was somewhat lost in the hype.

After awhile, the local media found other stories to publish and left us alone. But at the Delaware County Office of the Medical Examiner, six staff members were left stunned, traumatized, and overwhelmed in the wake of the past year's events.